The challenges of BC’s COVID-19 vaccination campaign

The COVID-19 vaccination campaign is unlike any other vaccination campaign in recent memory. Despite the many unprecedented challenges we’ve overcome, vaccinating British Columbians is designed to stop the spread and prevent serious illness and death. Over the last few months we are already seeing success, particularly in long-term care where nearly all residents and staff have been vaccinated, and the outbreaks and deaths have largely ceased.

Vaccine supply

Feedback from colleagues about the challenges experienced during the campaign rollout have changed over time. But the foremost challenge continues to be around vaccine supply – deliveries from the suppliers has been difficult to anticipate. Only Pfizer has the most consistent delivery schedule. The province has the capacity to administer many more vaccines on any given day, if only the supply was there. When the campaign began earlier than originally expected (a pleasant surprise, but not without its attendant difficulties), supply was severely constrained, which led to extraordinary challenges around “choosing” who would be vaccinated first. With some two-thirds of COVID-19 deaths occurring in long-term care it was rational to vaccinate the more vulnerable residents and staff first. Essential visitors were also vaccinated – a decision that triggered angst among some. However, it quickly became evident that these “visitors” play vital roles in caring for their loved ones in long-term care who were otherwise rapidly declining because of the isolation they now found themselves in.

Vaccinating healthcare workers was stratified based on the impact that their loss might have on the functioning of the healthcare system. This too was accompanied by controversy. While it was obvious that staff in emergency departments, intensive care units, and COVID-19 wards needed to be prioritized, what about the other vital functions of the healthcare system? How does one choose between different medical wards and surgical units? And what about health care workers in the community outside of hospitals? Those decisions would not have been so difficult had there been more vaccine, but supplies have remained tight from the beginning. Those earliest days and weeks triggered much of the frustration experienced by our colleagues. Most generally understood that tough choices had to be made in the face of limited supplies, but it was a lot harder to live it.

Timeline between vaccine doses

In the midst of the supply crunch came one of the most difficult decisions of all – to extend the interval between vaccine doses from 21 days to 42 days, and eventually to 4 months. This elicited some of the strongest feedback I have seen in my medical career. Many colleagues who had received their first dose were surprised by the decision, expecting to receive their second dose in the timeframe recommended by the manufacturer. Some wrote in to challenge the decision and rationale. And others, many of whom had not yet received their first dose, wrote in support of the decision. In the end, of course, it all came down to supply. With the vast majority of British Columbians remaining susceptible to COVID-19, the choice was clear – extending the timing of the second dose meant more individuals would receive their first dose sooner, ultimately enabling far greater numbers of people to be protected in a shorter time frame. Evidence around the world, particularly in the UK, shows that getting as many people vaccinated with at least one dose as quickly as possible has tremendous impacts on hospitalizations and deaths. The real-world data in BC has been similarly reassuring.

Family doctors involvement in vaccination campaign

Lastly, one of the most consistent challenges I’ve heard is from colleagues feeling left out of campaign planning and implementation. It has been one of the most difficult challenges for a profession that prides itself on being action-oriented. However, to say that doctors have not been involved at all in the vaccine campaign would be a misrepresentation. Doctors have been involved in the conception, leadership, and implementation of the campaign at all levels – from Public Health, to Immunize BC, to giving shots at drive-through clinics. It is true that not every doctor has been consulted and many who have volunteered to assist the campaign have not been called up. It can be frustrating to see other healthcare professionals such as pharmacists and nurses called upon to provide vaccinations while doctors are seemingly idle. And it is frustrating to hear about new developments and changes in strategy with little or no warning. This all points to a vaccine campaign unlike any before it, one that moves fast, has numerous moving parts, and is completely new. Supply changes, new evidence, updated guidelines… they’re happening at an extraordinary pace with incredible pressure on the campaign to deliver quickly. Normally, it takes years for evidence to trickle down into clinical practice and guidelines to be updated. We are now seeing this process unfold in as little as a few days. This leaves little time to consult widely and prepare front-line clinicians for the changes, yet it is the front-line clinician who is often the most impacted.

What I can tell you is that there is a group of clinicians who work on the front-lines who have taken extraordinary effort to inform the vaccine campaign. These colleagues are not the usual suspects. They are not the named health systems leaders but they are committed, they experience the realities of clinical practice every day, and they are doing all of British Columbia an important service by contributing their know-how to this campaign. They don’t always get what they, or we, want. Supply challenges, logistics, the strain on healthcare staff, limitations on information systems, and the race against COVID-19 all contribute to scuttle some ideas and even the best-laid plans. But at the end of the day we all want a swift end to this pandemic. BC’s vaccine campaign isn’t perfect, but this hasn’t been a perfect year. This campaign is the best attempt, with our best people, with our best knowledge, to protect as many British Columbians as quickly as possible from serious harm. There have been bumps in the road and there may be more. There have been changes in strategy and there may be more. But one thing is certain: We will get the job done.

- Dr Matthew Chow